9 Belbuca Side Effects You Should Know About

Belbuca (buprenorphine) is a medication that’s FDA-approved for severe, chronic pain. It’s typically reserved for situations where other pain medications haven’t worked or can’t be used. 

Belbuca is a partial opioid agonist that’s typically taken twice a day. It’s a buccal film that’s placed on the inside of your cheek, where it will dissolve and enter your bloodstream.

There are several other forms of buprenorphine, but we’ll focus only on Belbuca in this article. Here, we’ll cover nine Belbuca side effects, and how to prevent or manage them.

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Belbuca side effects at a glance

Using Belbuca correctly, and at the lowest effective dose, is recommended. However, even with doing so there is a risk of side effects.

Common, often mild, Belbuca side effects include:

• Nausea and vomiting

• Constipation

• Headache

• Dizziness

• Mouth irritation

• Tiredness and lack of energy

More serious Belbuca side effects include:

• Impaired ability to drive or do other activities, which can lead to accidents and injuries

• Dental problems

• Severely low blood pressure

• Heart rhythm problems (long QT syndrome)

• Liver problems

• Low cortisol levels

• Severe constipation in those with existing bowel obstruction (blockage in the intestines)

• Increased risk of seizures in people with seizure disorder

• Increased pain sensation (opioid-induced hyperalgesia)

• Opioid withdrawal symptoms, which may be severe in some cases

Belbuca also has a few boxed warnings. These are the FDA’s strictest warnings for medications. While rare, these risks can be severe and even life-threatening in some cases. Belbuca boxed warnings include:

• Misuse, which can lead to overdose and death

• Slowed breathing and overdose

• Overdose in people accidentally exposed to Belbuca, especially children

• Withdrawal symptoms in newborns who were exposed to Belbuca during the mother’s pregnancy

EXPERT PICKS: WHAT TO READ NEXT

• Buprenorphine is considered an opioid, but it works in unique ways. Learn how buprenorphine-containing products work to treat chronic pain and opioid use disorder.

• Here are tips for talking about your chronic pain. Consider these tips for being honest and detailed when discussing chronic pain with your healthcare team.

• Therapy can help with chronic pain. Certain types of therapy, including cognitive behavioral therapy, can help treat chronic pain.

1. Nausea and vomiting

Nausea is the most common Belbuca side effect. Stomach pain and vomiting are also possible.

Nausea is most likely after you start Belbuca or after your dose is increased. But for many people, nausea tends to improve over time. If you’re feeling nauseous, try eating smaller, but more frequent, meals or snacks throughout the day. Stay hydrated, and avoid fatty or spicy foods, which can worsen nausea. 

In some situations, your prescriber may recommend an over-the-counter (OTC) or prescription nausea medication. But don’t start a nausea medication without talking to your prescriber or pharmacist first. Some medications can interact negatively with Belbuca.

If your nausea continues without improvement, let your prescriber know. You may need a lower Belbuca dose or a different pain medication.

2. Constipation

Constipation is a common side effect of opioid medications, including partial opioid agonists such as Belbuca. It can happen at any point during treatment, and it doesn’t always improve once it starts. That’s why it’s best to try to prevent constipation from happening. Try staying hydrated, eating fiber-rich foods, and exercising regularly. 

If you’re prone to constipation, your prescriber may recommend starting an OTC laxative at the same time that you start Belbuca. Examples include senna (Senokot, Ex-Lax) or docusate sodium (Colace, DocQLace). Or, they may recommend taking both of them.

Although these products are available OTC, talk to your pharmacist or prescriber before trying them. Not all OTC laxatives work for medication-induced constipation. In some cases, a prescription laxative, such as Movantik (naloxegol) or Relistor (methylnaltrexone), might be recommended. These laxatives are specifically indicated to treat opioid-induced constipation.

3. Headache

Headache is another common Belbuca side effect. Avoid using opioids to treat headaches unless it’s recommended by your prescriber. Taking opioids with Belbuca can increase your risk of slowed breathing and overdose. Additionally, Belbuca can block the effects of other opioids, preventing them from being effective.

Instead, consider at-home headache remedies, including hydration, exercise, or meditation. Sometimes dietary changes can also help. You can also talk to your pharmacist about which OTC pain relievers are safe to take with Belbuca.

4. Tiredness and fatigue

Belbuca can cause drowsiness and fatigue, which can affect your ability to do tasks that require alertness. These include driving and operating machinery. For this reason, you should avoid driving or doing other activities that require alertness until you see how Belbuca affects you. 

This is especially important when you start taking Belbuca or after a dose increase. After you see how you react to Belbuca, talk to your prescriber about whether it’s safe to resume driving and other activities that require alertness.

It’s also important to avoid other medications or substances that can cause excessive drowsiness when combined with Belbuca. These include benzodiazepines, other opioids, and alcohol.

Although less common, Belbuca can also cause insomnia (trouble sleeping). And not sleeping well at night can worsen daytime drowsiness. So talk with your prescriber if you’re having trouble sleeping with Belbuca.

5. Dizziness

Dizziness is a common Belbuca side effect. It may be more likely when you start taking Belbuca or if your dose is increased.

Additionally, Belbuca can cause orthostatic hypotension, which can also lead to dizziness. Orthostatic hypotension is when your blood pressure drops during position changes, such as standing up or getting out of bed. Orthostatic hypotension puts you at risk for falls and injuries. This can be particularly dangerous for older adults, who are more prone to injury and hospitalization from falls.

Generally, dizziness from Belbuca is mild. It can be managed by moving carefully when changing positions. You also may need to sit or lie back down if you feel dizzy upon standing. But if your dizziness continues, let your prescriber know. They may recommend checking your blood pressure at home to see if it’s low. Or, they may want to further evaluate the cause of your dizziness. 

If your dizziness feels severe or you’re experiencing fainting or extreme weakness, seek emergency care.

6. Dental problems

Since Belbuca films dissolve in your mouth, mouth-related side effects — such as dry mouth — are possible.

More concerning, Belbuca can cause serious dental problems. These include cavities, mouth infections, and even tooth loss. Your risk may be higher if you have a history of dental problems, including cavities. 

If you take Belbuca, keep up with regular dental checkups. You can also take other steps to reduce your risk of dental problems:

• After Belbuca has fully dissolved, take a large sip of water, swish it gently around your mouth, and swallow. This will ensure none of the medication remains in your mouth. 

• Wait at least 1 hour before brushing your teeth after taking Belbuca. This helps prevent damage to your teeth.

7. Withdrawal

Opioid withdrawal symptoms occur when your body becomes reliant on having opioids in your system and your opioid levels drop too quickly. Although Belbuca is less likely to cause withdrawal than other opioids, it can still happen if you suddenly stop taking it or your dose is lowered too quickly. Sometimes, it may even happen if you simply miss a dose of Belbuca.

Additionally, Belbuca can trigger opioid withdrawal from other opioids. This is because Belbuca binds more tightly to opioid receptors than full opioids. So when you take Belbuca, it can block the effects of other opioids, leading to withdrawal.

Opioid withdrawal symptoms can include diarrhea, nausea and vomiting, and heart palpitations. You may also experience anxiety, restlessness, and tremors. If you’re interested in stopping Belbuca or reducing your dose, work closely with your prescriber to do so. They can reduce your dose slowly and safely to minimize your risk of withdrawal.

8. Misuse

Belbuca is a controlled substance. This means that it carries a risk of dependence and misuse, which can lead to substance use disorder. But the risk of misuse with Belbuca is lower compared with full opioid medications.

Still, misuse can happen, especially if you take Belbuca differently than how it’s prescribed. Be sure to follow your prescriber’s instructions when taking Belbuca. Don’t take more than what’s recommended. If your dose isn’t effectively controlling your chronic pain, let your prescriber know.

9. Overdose

Overdose can happen if you take too much Belbuca or take it more often than your prescriber recommends. It can also happen if you combine it with certain other substances that can cause slowed breathing and overdose, such as:

• Benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan)

• Other opioids, such as oxycodone (Oxycontin, Roxicodone) and tramadol (ConZip, Qdolo)

• Sleep medications, such as zolpidem (Ambien) and eszopiclone (Lunesta)

• Alcohol

It’s important to take Belbuca exactly as prescribed and avoid other substances that increase your risk of overdose. If you or a loved one experiences an overdose, it’s a medical emergency. Symptoms of an overdose may include inability to speak, slowed breathing, and a slow heart rate. Physical signs of overdose include pinpoint pupils, bluish skin, or vomiting.

If you think someone is having an overdose, administer naloxone (Narcan, Zimhi) or nalmefene (Opvee, Zurnai) right away if you have one of these medications on hand. These are life-saving medications that can quickly reverse the effects of an opioid overdose. Naloxone nasal spray is available OTC, while nalmefene products are available by prescription only.

After administering naloxone or nalmefene, call 911 immediately. The person overdosing still needs emergency care. Naloxone and nalmefene effects are temporary and don’t replace care at the hospital.

How to use Belbuca film to reduce side effects

Taking Belbuca correctly minimizes the chance you’ll get too much medication, which can increase the likelihood of side effects and overdose. 

Belbuca films should be placed against the inside of your cheek and allowed to dissolve completely. This usually occurs within 30 minutes. Although buprenorphine sublingual tablets can be placed under the tongue, Belbuca films shouldn’t be. Additionally, you shouldn’t eat, drink, or touch the film with your finger or tongue while it’s dissolving.

Belbuca films should not be swallowed or chewed. Additionally, avoid placing Belbuca films on open sores or cuts inside your mouth. Doing so increases your risk of getting too much Belbuca into your bloodstream.

Lastly, store your Belbuca in its sealed foil pouch in a safe location away from other people. Accidental exposure to even one film can cause an overdose for people who aren’t used to taking opioids, especially children.

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Written by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Bailey E. Eason, PharmD, MS, BCPS

Bailey Eason has been licensed for 6 years and has held licenses in three states (North Carolina, Virginia, and Illinois). She has held positions as a health-system pharmacy administration resident, operating room pharmacy manager, pharmacy manager of clinical operations: surgery, neurology and controlled substances, and most recently as program director  of drug diversion for a large academic health system.

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